Conconi A, Zucca E, Roggero E, Bertoni F, Bernasconi A, Mingrone W, Pedrinis E, Cavalli F
Istituto Oncologico della Svizzera Italiana, Divisione di Oncologia Medica, Ospedale San Giovanni, Bellinzona, Switzerland.
Hematol Oncol. 2000 Jun;18(2):61-73. doi: 10.1002/1099-1069(200006)18:2<61::aid-hon658>3.0.co;2-i.
Prognosis of DLCL patients is variable and associated with well-defined risk factors. In the past decade several pretreatment variables have been incorporated into prognostic models to predict the death risk of individual patients. The International Prognostic Index (IPI), developed in an international consensus study, has been one of the most widely accepted of these models. In our study we applied some of the major prognostic models proposed for DLCLs in a cohort of 111 patients uniformly treated with a CHOP-like regimen in order to compare their sensitivity and specificity. We also evaluated the possibility of improving the IPI with the inclusion, from among the variables analysed, of serum beta-2 microglobulin level (beta-2M). The sensitivity, reflecting the ability to predict all failures in the cohort of patients as a whole, has improved from 45 to 73 per cent when the beta-2M-IPI model is compared with IPI, without a significant loss of specificity. Based on these results, the beta-2M-IPI may be useful for identifying the subset of patients with very poor prognoses. Therefore, the use of the serum beta-2M value in addition to the IPI may help in selection of the patients with DLCL at higher risk for treatment failure, and identification of those who may require specifically tailored therapeutic approaches.
弥漫性大B细胞淋巴瘤（DLCL）患者的预后各不相同，且与明确的风险因素相关。在过去十年中，一些预处理变量已被纳入预后模型，以预测个体患者的死亡风险。国际预后指数（IPI）是在一项国际共识研究中开发的，是这些模型中最被广泛接受的模型之一。在我们的研究中，我们在一组111例均接受类CHOP方案治疗的患者中应用了一些针对DLCL提出的主要预后模型，以比较它们的敏感性和特异性。我们还评估了从分析的变量中纳入血清β2微球蛋白水平（β2M）来改进IPI的可能性。当将β2M-IPI模型与IPI进行比较时，反映预测整个患者队列中所有失败情况能力的敏感性从45%提高到了73%，而特异性没有显著损失。基于这些结果，β2M-IPI可能有助于识别预后非常差的患者亚组。因此，除IPI外使用血清β2M值可能有助于选择治疗失败风险较高的DLCL患者，并识别那些可能需要特殊定制治疗方法的患者。
